Background
Orthostatic hypotension (OH) is highly prevalent in the elderly, and this population
can be exposed to serious complications, including falls and cognitive disorders,
as well as overall mortality. However, the pathophysiology of OH is still poorly understood,
and innovative methods of cerebral blood flow (CBF) assessment have been required
to accurately investigate cerebrovascular reactivity in OH.
Objectives
We want to compare brain tissue pulsatility (BTP) changes during an orthostatic challenge
in elderly patients over 80 with and without OH.
Materials and Methods
Forty-two subjects aged 80 and over were recruited from the geriatric unit of the
Hospital of Tours, France, and were divided into two groups according to the result
of an orthostatic challenge. The noninclusion criteria were any general unstable medical
condition incompatible with orthostatic challenge, having no temporal acoustic window,
severe cognitive impairment (Mini Mental Status Examination <15), history of stroke,
and legal guardianship. We used the novel and highly sensitive ultrasound technique
of tissue pulsatility imaging to measure BTP changes in elderly patients with (n = 22)
and without OH (n = 17) during an orthostatic challenge.
Results
We found that the mean brain tissue pulsatility related to global intracranial pulsatility,
but not maximum brain tissue pulsatility related to large arteries pulsatility, decreased
significantly in OH patients, with a delay compared with the immediate drop in peripheral
blood pressure.
Conclusion
Global pulsatile CBF changes and small vessels pulsatility, rather than changes in
only large arteries, may be key mechanisms in OH to account for the links between
OH and cerebrovascular disorders.
Key Words
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Article info
Publication history
Published online: November 25, 2016
Accepted:
September 3,
2016
Received:
June 15,
2016
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.09.002
Copyright
© 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.
